Long-Term Care Staffing, COVID-19, and Lessons for Resilient Services

February 16, 2024

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Our article developed from practicum work Tessa Weinberg did with us at AGE-WELL National Innovation Hub – Advancing Policies and Practices in Technology and Aging as part of her MSc program at McMaster University. She compared pre-pandemic challenges facing Ontario’s and British Columbia’s (BC) long-term care (LTC) sectors, and the measures each province took in early 2020 to protect LTC residents from COVID-19.

Adequate LTC staffing is essential for maintaining everyday quality of care, and for protecting residents during crises, so we focused the article on workforce policies. We found that the topic had been on agendas in Ontario and BC for over twenty years, and the provinces differed in their approaches to increase staffing. Ontario relied on targeted funding for hiring workers, but high LTC sector turnover meant that improvement was not sustained. BC opted to change the LTC fee structure, which provided a small but secure funding increase. BC LTC operators used a large proportion of the money to add positions, and staffing rates climbed to a new plateau, albeit one that remained below the provincial target of 3.36 care hours per resident per day. As a result, BC’s LTC sector was better situated than Ontario’s early in the pandemic, at least for implementing measures that depended on staff availability.

Systems without spare capacity quickly become overloaded, or collapse entirely, when faced with demands that exceed routine needs. Prioritizing cost reduction in emergency response departments or ministries potentially leads to decisions that undermine capacity in crucial ways. The Ontario/BC example illustrates how policies implemented long before a crisis occurs constrain options when one happens. Here, efforts to control health care provision expenditures resulted in arguments for decades about what to cut, and in long-term care inadequate resourcing for staff created vulnerabilities when protecting residents from COVID-19. Impacts of the pandemic on the LTC sector show how expensive attempting to expand capacity mid-crisis can be, both financially and in the toll on human lives.

Our findings also illustrate that some policies to address shortfalls in publicly-funded systems work better than others. The attraction of targeted initiatives is understandable — they are straightforward to implement, demonstrate that action is being taken, and do not lock governments into lengthy spending commitments. Unfortunately, they also may not address systemic problems that perpetuate shortages, in this case low wages, casual employment, and staff burnout in LTC. When that happens, targeted incentives are like trying to top up a damaged bucket without plugging any holes — you may fill the water to the top, but it soon returns to the original level. Viewed in the longer-term, policies that equip front-line managers with stable resources to fill gaps, and keep them filled, are more likely to produce lasting improvement.

Relative financial costs and benefits of policy options are important, but in the current context, marked by environmental and social volatility and a range of emerging crises, it may be time to consider making systemic resilience a central goal for policy making.

PATRICK B. PATTERSON, PhD. is a Knowledge Broker in the AGE-WELL National Innovation Hub – Advancing Policies and Practices in Technology and Aging (APPTA). He is a social anthropologist, with a background in studying organizations and policy formation. He has researched workplace health and safety policies in the B.C. forest industry and Alberta petroleum industry, smoking and vaping policies in health and university settings, and health system policies in the Republic of Malawi in southern Africa. He feels that insights into the social and cultural aspects of how policies are made can help facilitate the adoption of evidence-based decisions. Within the APPTA Hub, his primary focus is supporting research and knowledge translation activities by looking at contexts, people and processes that lead to policy decisions.

Long-Term Care Staffing Policies Pre-COVID-19 and Pandemic Responses: A Case Comparison of Ontario and British Columbia was published in Volume 49, Issue 1 of Canadian Public Policy. 

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